Metaplastic transformation of the esophagus, termed Barrett's esophagus (BE) is a premalignant condition with a 1 per 200 patient-years risk of malignant progression to esophageal adenocarcinoma. The incidence of esophageal adenocarcinoma has increased dramatically, over three fold in the past three decades, while the prognosis of this cancer has remained poor. Detection of early cancers within a BE surveillance program is currently the only hope for improving prognosis. BE is associated with chronic gastroesophageal reflux, however, screening endoscopy for BE in these patients cannot be recommended because it is expensive and there is insufficient evidence to support its efficacy. Since endoscopy is not performed in most individuals with gastroesophageal reflux symptoms and 4 in 10 patients with BE are also asymptomatic, current medical practice in the United States detects only a minority of BE cases. Clearly we need more effective methods for BE screening. Esophageal capsule endoscopy and transnasal esophagoscopy are two novel unsedated endoscopic methods for esophageal examination. Capsule endoscopy is more expensive and likely not as sensitive as TNE. However, it may be more acceptable than TNE as a screening examination. To determine which is preferable for BE screening we propose research comparing the effectiveness of these two new modalities with the following Specific Aims - 1) train physician extenders at a VA in the performance of both procedures;2) compare acceptability when the two procedures are used for BE screening in primary care clinics at a VA;and 3) measure and compare patient satisfaction with the two procedures. This research will identify which of the two unsedated procedure should be implemented in BE screening. PUBLIC HEALTH RELEVANCE: Cancer of the esophagus has a poor prognosis unless it is detected early. Barrett's esophagus is a pre- cancerous condition that is diagnosed by endoscopy, however most individuals with Barrett's esophagus remain undetected. The proposed research will compare two new techniques, a wireless video capsule and an ultraslim endoscope, for detecting Barrett's esophagus. The results will define whether these techniques are accepted and well tolerated by veterans at a Veterans Affairs hospital and determine how satisfied they are with screening examinations performed by nurse practitioners and physician assistants. Ultimately, this study will lead to more effective screening programs for Barrett's esophagus.